Burden of Multidrug-Resistant Uropathogens and Their Antimicrobial Susceptibility Among Hospitalized Patients: A...

Background Urinary tract infections (UTIs) represent a major global health challenge, with the rise of multidrug-resistant (MDR) uropathogens significantly complicating empiric treatment and increasing medical costs. The objective of this study was to determine the local burden of MDR UTIs and the patient characteristics associated with it, characterize the causative pathogens, and describe their antimicrobial susceptibility patterns in a community hospital setting. Methods A retrospective cross-sectional study was conducted at Phelps Hospital in Sleepy Hollow, NY, USA, utilizing 392 urine samples collected from inpatients between February and May 2026. MDR status was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Bacterial isolates were identified using automated methods, followed by antimicrobial susceptibility testing interpreted according to Clinical and Laboratory Standards Institute (CLSI) 2022 guidelines. Results Among 286 symptomatic patients, 70 (70/286; 24.47%) had MDR UTIs. Escherichia coli was the predominant pathogen (48/70 samples; 68.6%), of which 47.91% (23/48 samples that grew Escherichia coli) were extended-spectrum beta-lactamase (ESBL)-producing. A significant finding was that among the MDR isolates that grew Enterococcus, all were vancomycin-resistant. The most common clinical characteristics associated with MDR infection were prior antibiotic use within six months (42/70; 60%) and hospitalization within the previous year (41/70; 58.7%). Susceptibility data revealed high activity of carbapenems and tigecycline against the majority of MDR gram-negative isolates in this cohort. Conversely, high resistance rates were observed for fluoroquinolones and trimethoprim-sulfamethoxazole (TMP-SMZ), making them unreliable for empiric use in this population. Conclusion The high prevalence of ESBL-producing Enterobacterales and vancomycin-resistant enterococci (VRE) in this cohort emphasizes the critical need for routine urine culture and susceptibility testing to guide effective therapy. Implementing antibiotic stewardship programs and utilizing local resistance data are essential to prevent the further emergence of resistance and to preserve the efficacy of last-resort antibiotics.